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Should Your Child See a Doctor?

Nosebleed

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Definition

  • Bleeding from 1 or both nostrils
  • No known injury

Causes 

  • Nosebleeds are common because of the rich blood supply of the nose. Common causes include:
    • Dryness of the nasal lining (e.g., from forced-air furnace in winter)
    • Antihistamine (Reason: they also dry the nose)
    • Vigorous nose blowing
    • Ibuprofen and aspirin (Reason: increase bleeding tendency)
    • Suctioning the nose can sometimes cause bleeding
    • Picking or rubbing the nose
    • Predisposing factors that make the nasal lining more fragile: nasal allergies, colds and sinus infections
     

When to Call Your Doctor for Nosebleed

Call 911 If…

 
  • Your child has fainted or is too weak to stand
 

Call Your Doctor Now (night or day) If

 
  • You think your child has a serious injury
  • Bleeding does not stop after 10 minutes of direct pressure applied correctly and tried twice
 
  • New skin bruises or bleeding gums not caused by an injury are also present
  • Large amount of blood has been lost

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Age under 1 year old
  • New-onset nosebleeds are occurring frequently
  • Hard-to-stop nosebleeds are a recurrent chronic problem
  • Easy bleeding present in other family members
 

Parent Care at Home If

  • Mild nosebleed and you don't think your child needs to be seen
 

Home Care Advice for Nosebleed

  1. Reassurance:
    • Nosebleeds are common.
    • You should be able to stop the bleeding if you use the correct technique.
     
  2. Apply Pressure:
    • Gently squeeze the soft parts of the lower nose against the center wall for 10 minutes. This should apply continuous pressure to the bleeding point.
    • Use the thumb and and index finger in a pinching manner.
    • If the bleeding continues, move your point of pressure.
    • Have your child sit up and breathe through the mouth during this procedure.
    • If rebleeds, use the same technique again.
     
  3. Insert Gauze:
    • If pressure alone fails, insert a gauze wet with a few decongestant nose drops (e.g., nonprescription Afrin). (Reason: The gauze helps to apply pressure and nose drops shrink the blood vessels).
    • If not available or less than one year old, use petroleum jelly applied to gauze.
    • Repeat the process of gently squeezing the lower soft parts of the nose for 10 minutes.
     
  4. Prevent Recurrent Nosebleeds:
    • If the air in your home is dry, use a humidifier to keep the nose from drying out.
    • Apply petroleum jelly to the center wall of the nose twice a day to promote healing.
    • For noseblowing, blow gently.
    • For nose suctioning, don't put the suction tip very far inside. Also, move it gently.
    • Avoid aspirin and ibuprofen (Reason: increase bleeding tendency).
     
  5. Expected Course: Over 99% of nosebleeds will stop following 10 minutes of direct pressure if you press on the right spot. After swallowing blood from a nosebleed, your child may vomit a little blood or pass a dark stool tomorrow.
  6. Call Your Doctor If:
    • Unable to stop bleeding with 20 minutes of direct pressure
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. Alvi A and Joyner-Triplett N. Acute epistaxis: How to spot the source and stop the flow. Postgrad Med. 1996;99:83-96.
  2. Guarisco JL and Graham III HD. Epistaxis in children: Causes, diagnosis and treatment. Ear Nose Throat J. 1989;68:522-538.
  3. McIntosh N, Mok J, Margerison A. Epidemiology of oronasal hemorrhage in the first 2 years of life: implications for child protection. Pediatrics. 2007;120(5):1074-1078.
  4. Mulbury PE. Recurrent epistaxis. Pediatr Rev. 1991;12:213-216.
  5. Sharathkumar AA, Pipe SW. Bleeding disorders. Pediatr Rev. 2008;29(4):121-129.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/18/2010 6:17:59 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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